I need to educate my daycare about toddler sunstroke.
May 7, 2013 12:22 PM   Subscribe

I am looking for a) a threshhold or medical recommendation of how long a toddler can remain in direct sunlight at temperatures of 77 degrees (25 Celcius) and above - before heat or sunstroke occur b) recommendations on how to prevent sunstroke.

I'd like to hear your answers based on knowledge and experience, but am also looking for some reputable information from a medical site that I can print out and take to the daycare.

The reason I am asking is that last summer, my toddler had a moderate case of one or the other causing a moderate fever. I was livid. I believe she was out in the sun for 1.5 hours. They typically take them outside and leave them to run around in the play area until parents arrive, which, for me is about 5:30.

Yesterday, she was outside playing in a sweater when I got there. It was about 80 degrees (28 or so Celcius). I told them that this was ridiculous and if she gets ill again this year, I will be calling the inspector.
posted by kitcat to Health & Fitness (24 answers total)
I think she can stay outside as long as she likes, IF she is a) wearing sunscreen, b) wearing heat appropriate clothing, c) drinking adequate water, and d) has access to shade to rest and take a break.

If she is playing outside in 80 degree weather she should be wearing shorts and a t-shirt. Perhaps you can dress her in layers so that they can take off the sweater and long pants (or send layers on the side) to play outside?

In the summer many toddlers spend hours playing outside in the backyard, on the playground, or at the pool.
posted by amaire at 12:28 PM on May 7, 2013

77 degrees, even in direct sun, isn't all that hot. You'll need to make sure she's dressed appropriately for the weather (on preview - layers are good!) and that daycare has ample sunscreen (that you have supplied and given them permission to apply).

You say the incident happened last summer. So your child is now 10-12 months older than when the last episode happened, which means not only is her body much better at regulating its own temperature, but she's also better able to make decisions such as "I'm hot, it feels nice in the shade, I'll go over there" or "I'm thirsty, I'll ask my teacher for water or juice".

While heatstroke and sunstroke are very real concerns in the dead of summer, the weather you've described doesn't seem at all dangerous if shade, hydration, and weather-appropriate clothing are all in good supply.

If you think your child is especially susceptible to these conditions, consult your pediatrician for guidelines that you and your daycare provider can use specifically for your child.
posted by trivia genius at 12:35 PM on May 7, 2013 [7 favorites]

Here are some basic guidelines from the American Academy of Pediatrics regarding extreme temperatures. There is a list of resources at the bottom that may also be worth exploring.
posted by pecanpies at 12:35 PM on May 7, 2013

As the father of a young daughter and as someone who is very wary of hot sun, I agree with what amaire said, but I would also add the importance of the children being supervised by adults who are well informed about the risks of excessive sun and heat exposure. Also, wearing a light weight sun hat is a good idea.
posted by Dansaman at 12:36 PM on May 7, 2013 [1 favorite]

Here is what the CDC has to say on the subject.

Where I am from, lots of families with very young children spend the entire day at the beach in much hotter weather (I'm an adult and can't handle a full day at the beach, for what it's worth). They often, but not always, wear hats and long-sleeved shirts and they are slathered in sunscreen every hour or so, have access to plenty of water, and can rest in a shady area.
posted by halogen at 12:39 PM on May 7, 2013

If these are not dangerous temperatures (where I'm from, I'm pretty sure we generally consider them to be for children in the sun too long), then what would have caused the heat or sunstroke (I really don't know which it was)?

I don't know (at 2.5) that she is able to logic out that she needs the shade. Or be able to curb her enthusiasm for playing and go and sit in it.
posted by kitcat at 12:56 PM on May 7, 2013

then what would have caused the heat or sunstroke (I really don't know which it was)?

What other symptoms did she have besides the fever? Did you get her medical care who told you this was sunstroke? Little kids get weird fevers for all kinds of reasons; are you certain it was even related, or could it have been a coincidence.

Agreed that even when my child was a toddler, we would spend the entire day at the beach pretty routinely with no ill effects.

Absolutely make sure the childcare has appropriate clothing available (layers, a change of outfit, etc.) and that they have sunscreen and permission to use it. Also make sure they are keeping her hydrated.

Generally, though, playing outside all afternoon in nice weather is something I'd find desirable in a child care (assuming the children are supervised, of course) rather than something to get upset about.
posted by anastasiav at 1:16 PM on May 7, 2013 [6 favorites]

it's more likely that last year your kid was dehydrated and not actually suffering from "sun stroke". an hour and a half running around in 80 degree weather is generally not too much for a kid unless they have some underlying condition, are not well hydrated, etc. make sure to teach your daughter to ask for water when she is thirsty. or, as we did in day care when i was a kid, have forced drinking fountain breaks every X minutes on the very hottest of days. she should also be wearing sunglasses at all times.
posted by misanthropicsarah at 1:20 PM on May 7, 2013

She should also be wearing sunglasses at all times.

What? While sunglasses are a good idea if your kid is going to be in the sun, I don't think this is realistic given children's tolerances for sunglasses, their likelihood of losing them, etc. And it's just one more detail that is out of the OP's control in regards to daycare.

That said, I think a pediatrician talk is warranted if you think your child is susceptible to heat stroke. My kid is close to 2.5 and while each child will develop at their own pace she seems to recognize and identify when it's "so hot, mama!" and tell me when she is thirsty. I also think daycares tend to be diligent about water and snacks but it's always worth asking how they treat these sunny playtimes.
posted by amanda at 1:24 PM on May 7, 2013

Sunglasses are generally recommended as just as important as covering up, hat, and sunblock where I'm from. There are obviously cultural differences.
posted by gaspode at 1:31 PM on May 7, 2013 [1 favorite]

I should have given a better description of her symptoms:

- very red skin on face
- eyes red and bloodshot
- temperature of 38.4 or 101.1
- body very hot to touch
- cranky, weepy, passive
posted by kitcat at 1:34 PM on May 7, 2013

Based on what my 2.5 year old does, I'd place money on dehydration first. My son's daycare has a shady spot and a basket full of the kids' waterbottles. The teachers are pretty good about getting some water and maybe a sit in the shade for the red-faced ones, but he still chugs a ton of water as soon as we leave. As for the diagnosis, here are some signs and symptoms. (That site I linked is where I take a lot of my cues from. There's certainly a danger, but my approach with my personal daycare, who I trust a lot, would be to ask how they deal with overheated children, not to call the cops on them.)
posted by tchemgrrl at 1:37 PM on May 7, 2013 [3 favorites]

I am going to stop thread-sitting right now. Please, I know my child and I know it wasn't a virus making her sick that day last year. Also, I did not threaten to call the police, but rather to file a report with the daycare inspection agency.
posted by kitcat at 1:41 PM on May 7, 2013

80 degrees Fahrenheit is a perfectly reasonable temperature for children to play outside all day, assuming that they are clothed appropriately (not in a sweater), have enough to drink, and are protected from sunburn.
posted by Ery at 2:04 PM on May 7, 2013 [3 favorites]

I'm sorry I don't have a link or anything, but I just wanted to let you know that my son's daycare had a chart by the door with temperature ranges and the corresponding times they were allowed to be outside. I remember glancing at it once and finding it surprisingly conservative - like VERY short times allowed outside for temperatures that were high but not THAT high. I'm talking 10-15 minutes, or NO outside time (but I can't remember the temps, sorry!)

I don't know about your kid, but mine will/would not regulate himself at all. He will run himself to the point of puking if he has the chance to play freely outside in very warm weather (it has happened many times.) You aren't being unreasonable.
posted by peep at 2:04 PM on May 7, 2013 [2 favorites]

If children had enough sense to get out of the sun/get more water/stop and rest, they would not need child care. The adults are hired to see to those things.
posted by Cranberry at 2:15 PM on May 7, 2013 [1 favorite]

My 2.5 year old was out yesterday in 80+ degree temperatures for well over an hour without any ill effects. And we live in Seattle, it's not like he's hardened to tropical heat. I think you're looking for a hard-and-fast physiological line that just isn't there. If your child needs extra care around heat and sunlight, then obviously your day care needs to abide by your wishes and your knowledge of what's best for your kid.
posted by KathrynT at 2:27 PM on May 7, 2013 [4 favorites]

Here are Ohio's guidelines. According to the state of Ohio, 80 degrees is fine for outdoor play. I think the problem is less the outdoor temperature and more the fact that your child was overdressed for perfectly appropriate playground play. I would not focus on the temperature but rather the fact that the staff is not making sure the kids are appropriately dressed (or undressed) for the weather. This will go a long way to avoiding overheating.
posted by DarlingBri at 2:34 PM on May 7, 2013 [5 favorites]

I live in toronto, and 25 degrees is certainly not what we'd consider to be too hot to be outside here.

Toddlers get sick, it's what they do.
posted by Kololo at 4:20 PM on May 7, 2013

I suggest that you talk to your child's teachers. I do not recommend confronting the teachers; instead, use this discussion to bring up your concerns, ask them to keep a closer eye on your child, and see how things work from there. I recommend bringing up both the sweater and your child's symptoms from last year.

Then, I suggest that you speak with the program director. He/she should have guidelines about when the kids can go outside (based on the temperature), how long they can be outside, etc.

Agree with the other posters who said they didn't think your child had sunstroke. I'm an ex-preschool teacher. I taught preschool in the South, where the summer days are often over 90 degrees, with 100% humidity, and the school wouldn't have had restrictions at the temperatures you mentioned in your post.
posted by emilynoa at 6:26 PM on May 7, 2013

With appropriate sunscreen and hydration, we'd let the kids play all day at the beach in higher temps than that. Also, if I'm reading your question correctly your child was outside from 4pm to 5:30pm. Those are not intense sun hours.

I'm not doubting your assessment, but since you're sure it's sunstroke it's worth looking at what the cause might have been. Ninety minutes in the late afternoon sun seems to be off the mark. Perhaps they were outside longer or they didn't receive adequate hydration.
posted by 26.2 at 7:09 PM on May 7, 2013

I work in a daycare (in muggy New Orleans), and in my experience, some kids will self-regulate, some won't. We have 5-year-olds we have to park in the shade and convince to drink water every 15 minutes. If it's really hot, we stay inside. Humidity is more the issue, I think--very muggy days are higher-risk.
I think it does sound like it could have been heat exhaustion (I think "sunstroke" is used interchangeably to mean the same thing, but medically, it's more severe and requires hospitalization), and some discussion with the teachers is in order. They should have ample shade and lots of available water, and maybe some quiet activities. When it's hot out we try to steer the kids towards calmer activities like the sand tables or outdoor story time.

Two random bits of practical advice:

Make sure there are several changes of clothing available, in different warmnesses, at all times. Only today I had to go borrow a tank top for a kid who was sent to school in a cardigan (and no shirt under) and had nothing in her cubby. Maybe you are that one parent who stays on top of the extra clothes (in which case, bless you) but I am constantly trying to track down the right clothes for kids. They should always have at least one set of warm-weather stuff and one sweatshirt/long pants.

A small sippy cup with a handle. The handle is so important--it really helps kids keep track of their water and carry it with them.

You can also ask for her to get some Pedialyte in the afternoons to prevent dehydration.
posted by Nibbly Fang at 8:00 PM on May 7, 2013 [1 favorite]

Maybe this is going about this a different way, but my kid seems unable to process when he's overheated. When he was younger, we worked around this by asking the daycare if they could have him take off his sweater if it was reasonably hot. If it was really hot outside, they would have water available for the kids and it was not unreasonable to ask the daycare to make sure he drank water when the other kids did because, again, he wouldn't ask for a drink despite being totally parched.
posted by Wuggie Norple at 3:09 AM on May 8, 2013

I should have said heat stoke, and guess I meant heat exhaustion (we use tend to use heat and sunstroke interchangeably and never say heat exhaustion colloquially). Thank you for your answers. Something definitely went wrong with their care that day last year, and I am very scared of it happening again. The fact that no one even noticed she was in distress that day disturbs me greatly. I already put most of these suggestions into practice, but will definitely put more in place and talk to them again.

When I talked to them about the sweater yesterday (after the director had spoken to the staff), they said she had thrown a fit and only wanted to wear her sweater. The director told them that it doesn't matter how big a fit she throws, she can't be going outside and running around in a sweater in very warm weather. Thanks again.
posted by kitcat at 5:29 AM on May 8, 2013 [1 favorite]

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